Emergency Care In Crisis

October 17, 2006

Been to the emergency room lately? If so, it was probably crowded. Nationally, emergency room visits have increased 18 percent over the last decade while the number of facilities has decreased 12 percent.

Connecticut is not immune from that growing crisis. It has had a similar surge in emergency room use. Uninsured patients, an aging population, lack of primary care access and the inadequacy of mental health services in community settings are all factors that have stressed emergency care.

This is not good for patients, caregivers, the insurers that pay far steeper fees for emergency treatment and policy-holders whose rates go up. The crowding also compromises the state's ability to respond to a pandemic or disaster.

At a recent hearing co-hosted by state Rep. Peggy Sayers of Windsor Locks, a nurse and co-chairman of the General Assembly's public health committee, doctors, nurses, hospital administrators and state officials got together to talk about the problem, which is the first step toward solving it.

Still, there's a cloud on the horizon that could complicate the already gloomy picture. The federal Center for Medicare & Medicaid Services is poised to change the reimbursement rates for Connecticut's four satellite emergency facilities. These are unique facilities, among a handful across the nation that function as integrated components of hospitals. They are located in Winsted, Marlborough, Guilford and Groton, affiliated respectively with the Charlotte Hungerford Hospital, Middlesex Hospital, Yale-New Haven Hospital and Lawrence and Memorial Hospital.

The looming federal change would reduce the rate the government pays for Medicare and Medicaid patients from an emergency room rate to a far lower clinical rate, a reduction that could be fatal for some satellites. The justification for this change, according to the CMS regional office, is that the clinical rates apply to facilities open less than 24 hours. The idea is to prevent a proliferation of part-time medical facilities from charging emergency rates to be more profitable.

But Connecticut's not-for-profit hospitals cannot afford to staff these legitimate satellites round the clock. They perform emergency services and should be reimbursed as such, particularly given the crowding statewide.

The government should consider a separate set of rules to accommodate these existing satellite emergency facilities that serve a vital function at a high level of service but do not meet the 24-hour rule.